Thank you for submitting your documentation form for Antibiotic Wise teaching in BC. This information helps us better understand where in the province and what age groups have received Antibiotic Wise teaching. This information is being collected in accordance with FIPPA section 26(c). Your information will remain confidential. If you have any questions, please email info@antibioticwise.ca.
*When was the teaching done?
Month Year
Teaching date
*What is your designation?
If you are entering for someone else, please put the designation of the person who taught the material.
What Health Authority was the teaching located in?
What organization are you affiliated with?
Please list each teaching session in the form below (estimate if unsure).
Facility Type Participant
Description		 Name of Facility Postal Code of Facility # of participants (including staff/teachers)
1
2
3
4
5
6
7
8
Please share any feedback for us on the lesson plans, your teaching experience, or any suggestions for improvement?